Case Report
LESS
A rare, benign, tumor-splenic vein hamartoma
Turan Acar, Nihan Acar, Ahmet Atasever, Osman Nuri Dilek
ABSTRACT
Splenic hamartoma, which is one of the primary benign tumors of the spleen, is usually asymptomatic and is typically detected incidentally on imaging. It is also difficult to diagnose and to distinguish from malign tumors with preoperative tests, and therefore, splenectomy should be performed to confirm the histologi- cal diagnosis. Presently described is the case of a 58-year-old male patient who underwent laparoscopic splenectomy due to a splenic mass and was subsequently diagnosed with splenic hamartoma.
Keywords: Hamartoma; laparoscopic splenectomy; spleen.
Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
Received: 07.11.2017 Accepted: 17.01.2018
Correspondence: Turan Acar, M.D., Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
e-mail: drturanacar1982@gmail.com Laparosc Endosc Surg Sci 2017;24(4):139-140 DOI: 10.14744/less.2018.77487
Introduction
Primary benign tumors of the spleen are cyst, heman- gioma and hamartoma.[1] Hamartomas are usually asymp- tomatic and detected incidentally on imaging.[1,2] Since the first case of splenic hamartoma was described by Rokitan- sky,[3] more than 150 cases have been reported, with an in- cidence of 0.024% to 0.13% given in a review of autopsies.
It is a tumor that contains red pulp and may be of different sizes. Although it is more common among the elderly, it may occur in any age group. It is challenging to diagnose, as there may be different morphological variations.[4] In this case report, we aimed to present a patient who was diagnosed with splenic hamartoma after laparoscopic ex- cision.
Case Report
A 58-year-old male was referred to our clinic by our col- leagues from the department of infectious diseases with the preliminary diagnosis of splenic mass which had been detected incidentally while the patient had been
undergoing his follow-up tests due to previous diagnosis of Brucella. There was a palpable, nontender mass in the left upper quadrant on physical examination. Blood tests including tumor markers were normal. Abdominal ultra- sound showed a solid mass with the size of 6x7 centime- ter (cm) in the spleen. Magnetic resonance imaging of the abdomen also revealed the same lesion. A laparoscopic splenectomy was performed with these findings (Fig. 1).
The patient was discharged uneventfully on the third post- operative day. Histopathological and immunohistochem- ical result was reported as “Splenic Hamartoma” which was measured 13x10x5 cm. The patient has been stil fol- lowed up and there is no evidence of additional disorder.
Discussion
Most of the splenic hamartomas are asymptomatic and usually detected incidentally during autopsy or while performing screening tests for other reasons.[2] However, some huge lesions may display clinical signs such as splenomegaly, palpable mass, spontaneous rupture, ane- mia, thrombocytopenia and digestive symptoms.[5]
It may occur at any age group without showing any dif- ference in gender, but huge lesions are mostly seen in females, probably due to hormonal effects.[1] Tumor size ranges from a few millimeters to 20 cm.
Our patient did not have any complaints. The splenic mass was detected incidentally while the patient had been un- dergoing his follow-up tests due to previous diagnosis of Brucella. Tumor size was reported as 13 cm.
It is challenging to diagnose splenic hamartoma because of its variable histological appearance which is related to the ratio of cellular and vascular component it contains. Ul- trasonography findings generally involve hyperechogenic masses without cystic areas or calcifications.[5] It is detected as a hypervascular mass with color-duplex sonography. It appears as an encapsulated mass with smooth borders in abdominal tomography and magnetic resonance imaging.
[6] We also had similar findings in our case.
The origin of the splenic hamartomas is still controver- sial. Some consider them to be congenital malformations of the splenic red pulp, others to be neoplasms of the splenic red pulp or post-traumatic reactive lesions.[7] He- mangiomas, lymphangiomas, hemangioendotheliomas and angiosarcomas constitute pathological differential diagnosis. Radiological differential diagnosis includes inflammatory myofibroblastic tumor, lymphoma and metastatic tumors.[5]
It is difficult to distinguish splenic hamartomas from ma- lign tumors with screening tests. Therefore laparoscopic splenectomy should be performed in order to confirm the histological diagnosis when there is a suspicion
Disclosures
Peer-review: Externally peer-reviewed.
Conflict of Interest: None declared.
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140 Laparosc Endosc Surg Sci
Figure 1. Spleen hamartomu cross-sectional view.
